Pearls from Dr. Gary Schwartz
Mechanisms of hypercalcemia in malignancy:
1) Osteolytic metastases - seen commonly in breast cancer and multiple myeloma
2) PTH-related protein secretion - seen commonly in nonmetastatic solid tumors and non-Hodgkin lymphoma
3) Increased production of 1,25-dihydroxyvitamin D (calcitriol) - seen commonly in lymphomas
4) Ectopic PTH secretion - described in ovarian carcinoma, SCLC and NSCLC, thyroid papillary carcinoma, and pancreatic malignancy
Posted 06/20/16 11:24:55 AM by Anna Krigel
Management of severe hypercalcemia:
- Volume expansion with isotonic saline to maintain urine output at 100 to 150ml/hr
- Administration of calcitonin (4u/kg) every 6 to 12 hours for the first 48 hours
- Bisphosphonate administration with zoledronic acid (4mg IV) or pamidronate (60 to 90mg) once
Posted 06/20/16 11:31:13 AM by Anna Krigel
Posted 06/20/16 11:44:59 AM by Anna Krigel
Posted 06/20/16 02:38:22 PM by Anna Krigel
Posted 06/20/16 02:39:45 PM by Anna Krigel
BRCA-related hereditary breast and ovarian CA syndromes
- BRCA: highly penetrant germline mutations in BRCA1 or BRCA2 (autosomal dominant)
- ~20% of patients with a hereditary breast and ovarian cancer syndrome have a mutation in BRCA 1 or 2
- Also confer higher risk of second breast CA (often contralateral breast), MALE breast CA, fallopian tube CA, primary peritoneal CA, pancreatic CA, melanoma, endometrial CA
- Unaffected BRCA carriers?
- Clinical breast exams every 6 to 12 months beginning at age 25
- Annual breast magnetic resonance imaging (MRI) from ages 25 to 29 years
- Annual mammogram and breast MRI from ages 30 to 75
- Consideration of chemoprevention and risk-reducing mastectomy
Posted 11/22/16 09:12:47 AM by Matthew Cummings
Classic Chemotherapy/Onc Drug Toxicities
- Gemcitabine/mitomycin --> TTP
- Bleomycin/MTX --> ILD (pulmonary fibrosis)
- 5-FU --> mucositis
- Tacrolimus/cyclosporine/s/p BMT --> PRES
- Alkylating agents (cyclophosphamide, busulfan) --> myelodysplasia
- Thalidomide/lenalidomide --> VTE (DVT/PE)
- Rasburicase/dapsone/sulfa (less likely) --> hemolysis in G6PD deficiency
- Anthracyclines (doxorubicin), trastuzumab --> cardiomyopathy
- Cyclophosphamide/ifosfamide --> hemorrhagic cystitis
- Peripheral neuropathy --> vincristine
Posted 11/22/16 09:38:51 AM by Matthew Cummings
Cardiac Tumors -- Clinical Manifestations
- Embolization (usually systemic, can be pulmonic, embolic risk highest w/ LA tumors)
- CHF via valvular/outflow obstruction or valvular regurgitation
- Direct invasion of the myocardium (decreased LV function arrhythmias, heart block, pericardial effusion)
- Invasion of adjacent lung -- cough, SOB
- Constitutional symptoms
- Incredibly rare
- Imaging crucial to plan diagnostic/therapeutic approach (surgery vs no surgery) --> TTE, CT, MRI
- Angiosarcoma, rhabdomyosarcoma, fibrosarcoma, leiomyosarcoma
Posted 11/22/16 09:44:39 AM by Matthew Cummings
Olaratumab for soft-tissue sarcoma
- Standard therapy had long been doxorubicin +/- ifosphamide
- Lancet 2016 (Dr. Schwartz senior author): data supporting olaratumab (human anti-platelet derived growth factor MAB) + doxorubicin as preferred therapy for soft-tissue sarcoma
Posted 11/22/16 09:52:14 AM by Matthew Cummings
For further reading...
Posted 11/22/16 09:55:21 AM by Matthew Cummings
Osteogenic Sarcoma- Most Commonly in long bones (knee, shoulder)
- MC bone tumor
- Usually with distant mets - high survival rate
- Sun-burst appearance on radiography
- Onion skinning appearance on radiography
- Small round blue cell
- Translocation 11/22
Posted 02/21/17 10:28:56 AM by Adam Faye
- Chordomas are rare (1/1,000,000), slow growing, locally aggressive neoplasms of bone that arise from embryonic remnants of the notochord.
- These tumors typically occur in the axial skeleton and are most common in the sphenooccipital region of the skull base and in the sacral regions.
- In adults, 50 percent of chordomas involve the sacrococcygeal region, 35 percent occur at the base of the skull, and 15 percent are found elsewhere in the vertebral column.
- Initial Rx is surgical resection followed by radiation therapy if complete resection isn’t possible.
- Tumors are slow growing; Locally invasive with high incidence of local recurrence -> death due to uncontrolled local disease.
- Addition of radiation improves disease-free survival if unable to fully resected.
Columbia Combined Cancer Panel:
- Looks at over 400 common gene mutations; Almost 100 have targetable therapies.
Posted 02/21/17 10:38:21 AM by Adam Faye
Created by Christopher Kelly
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The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.